title: VA location and structural factors associated with on-site availability of reproductive health services.
abstract: BACKGROUND
  With the increasing number of women Veterans enrolling in the Veterans Health Administration (VA), there is growing demand for reproductive health services. Little is known regarding the on-site availability of reproductive health services at VA and how this varies by site location and type.
  
  
  OBJECTIVE
  To describe the on-site availability of hormonal contraception, intrauterine device (IUD) placement, infertility evaluation or treatment, and prenatal care by site location and type; the characteristics of sites providing these services; and to determine whether, within this context, site location and type is associated with on-site availability of these reproductive health services.
  
  
  METHODS
  We used data from the 2007 Veterans Health Administration Survey of Women Veterans Health Programs and Practices, a national census of VA sites serving 300 or more women Veterans assessing practice structure and provision of care for women. Hierarchical models were used to test whether site location and type (metropolitan hospital-based clinic, non-metropolitan hospital-based clinic, metropolitan community-based outpatient clinic [CBOC]) were associated with availability of IUD placement and infertility evaluation/treatment. Non-metropolitan CBOCs were excluded from this analysis (n = 2).
  
  
  RESULTS
  Of 193 sites, 182 (94 %) offered on-site hormonal contraception, 97 (50 %) offered on-site IUD placement, 57 (30 %) offered on-site infertility evaluation/treatment, and 11 (6 %) offered on-site prenatal care. After adjustment, compared with metropolitan hospital based-clinics, metropolitan CBOCs were less likely to offer on-site IUD placement (OR 0.33; 95 % CI 0.14, 0.74).
  
  
  CONCLUSIONS
  Compared with metropolitan hospital-based clinics, metropolitan CBOCs offer fewer specialized reproductive health services on-site. Additional research is needed regarding delivery of specialized reproductive health care services for women Veterans in CBOCs and clinics in non-metropolitan areas.
authors.affiliation: Health Services Research and Development (HSR&D), Department of Veterans Affairs (VA) Puget Sound Health Care System, University of Washington School of Public Health, 1660 S. Columbian Way S-152, Seattle, WA 98108, USA. jkaton@u.washington.edu
authors.forename: Jodie
authors.initials: J
authors.lastname: Katon
authors.forename: Gayle
authors.initials: G
authors.lastname: Reiber
authors.forename: Danielle
authors.initials: D
authors.lastname: Rose
authors.forename: Bevanne
authors.initials: B
authors.lastname: Bean-Mayberry
authors.forename: Laurie
authors.initials: L
authors.lastname: Zephyrin
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans; D058014:Veterans Health; D016387:Women's Health